US Health Insurance at a Glance

Does America have health insurance?
Healthcare in the United States runs on a complex bureaucracy. While in most other countries the majority of healthcare facilities are owned by the government or by private companies, in the US a large share of hospitals and clinics belong to private, nonprofit organizations.

Even so, the United States spends more on healthcare than any other country. It has the most expensive healthcare system in the world. A large part of this spending is carried by public payers such as federal agencies and state and local governments, but it can also be covered by private insurance and out-of-pocket payments.

At the same time, unlike most industrialized nations, the US healthcare system does not provide coverage for the entire population.

With no single nationwide health insurance system, the United States relies mainly on employers voluntarily offering health coverage to their employees and their families.

On top of that, there are government programs that cover healthcare costs for the most vulnerable groups in society, such as older people, people with disabilities and people on low incomes. These programs differ from one another, and each serves a specific group of people.

Getting health insurance in the USA is not easy. You might think that once you have money, everything is simple, but in reality it is a bit more complicated. You need to be careful and make sure you choose the right coverage.

1Health insurance in the United States for non-citizens

The US government does not provide health insurance for all citizens, and health insurance is not mandatory for everyone living in the US. It is optional, but highly recommended and necessary, because healthcare, such as a hospital stay, is very expensive, more expensive than anywhere else in the world. But your health is, of course, worth the money.

Health insurance in America
There are two kinds of health insurance in the US: private and public. Most people don't pick just one, but use a combination of both. The public health insurance programs in the US are Medicare, Medicaid and the Children's Health Insurance Program.

The US has the most expensive healthcare system in the world. That is why proper health coverage is strongly recommended.

2Medicare

Medicare is a national health insurance program dating back to 1966. It covers US citizens aged over 65, as well as younger people with end-stage kidney disease, ALS and certain other disabilities.

As of November 2025, around 69.7 million people were enrolled in Medicare, the vast majority of them aged 65 or older (CMS).

Medicare is divided into four parts:

• Part A: covers hospitals, skilled nursing care and hospice services.
• Part B: covers outpatient services, including some provider services during an inpatient hospital stay, and outpatient hospital costs
• Part C: an alternative known as Managed Medicare, which lets patients choose a health plan that covers at least the same benefits as Parts A and B, often includes Part D benefits, and has an annual out-of-pocket limit that A and B lack. To sign up for this part, you first have to enroll in Parts A and B.
• Part D: mainly covers self-administered prescription drugs.

3Medicaid

Medicaid is a joint federal and state program that helps people with limited income and resources cover medical costs, and it also covers services Medicare usually doesn't, such as home care and personal care services.

It is the largest source of funding for medical and health-related services for people on low incomes in the United States. The data show that 71 million people in the US with low incomes or disabilities are covered, which is 23% of the total US population.

4Children's Health Insurance Program

Formerly known as the State Children's Health Insurance Program (SCHIP), this program covers children from families whose income is low, but not low enough to qualify for Medicaid.

5The Affordable Care Act (Obamacare)

The Patient Protection and Affordable Care Act is a federal law signed by President Obama that originally required every citizen to take out US health insurance or pay a penalty. The federal penalty no longer applies since tax year 2019; some states, however, have their own insurance mandates. The law subsidizes low-income families by taxing healthcare providers and high-income families, with the aim of lowering healthcare costs while giving Americans better care.

The Affordable Care Act allowed parents to keep their children on their policies up to age 26, so that younger, healthy people also pay into the premiums. It also made it possible for poorer people to get treatment for chronic conditions instead of going to the emergency room.

6Private US health insurance

There are about a thousand private health insurers in the US, each offering different plans that depend largely on a person's medical history. Besides individual plans covering just one person, there are also group plans, aimed in particular at families.

Broadly, there are three types of health insurance in the United States:

• Traditional fee-for-service plans, which are usually the most expensive and hard to get for people earning below the US average income. They are, however, the best plans, because they give you the most flexibility.
• Health Maintenance Organizations (HMOs), which offer a limited choice of providers, but in return have lower copays and cover more preventive care. They are rated and accredited by the National Committee for Quality Assurance.
• Preferred Provider Organizations (PPOs), which, like HMOs, offer lower copays but give you more flexibility in choosing a provider, since you get a list of providers to choose from.

7How do you choose a good US health plan?

When looking for good US health insurance, ask yourself questions such as:

• Can you see any doctor, hospital, clinic and pharmacy you choose?
• Are specialists such as eye doctors and dentists covered?
• Does the plan cover specific conditions or treatments, such as pregnancy, mental health care and physical therapy?
• Does the plan cover home care or in-home nursing, and the medications a doctor may prescribe?
• How high are the deductibles? Are there copays?
• What is the maximum I have to pay out of my own pocket?

Also make sure you know how your provider handles disputes over a bill or a service, because with some plans you may have to let a third party decide how the issue is resolved.

8Health insurance requirements for foreign visitors to the US

Although US authorities do not require health insurance for short-term travelers on a B-1/B-2 visa, every traveler is strongly advised to get covered before traveling to the US.

The main reason to get insurance is that healthcare in the US is extremely expensive: even a checkup for a simple headache costs hundreds of dollars, and a broken limb costs thousands.

Health emergencies are never predictable, so it's best to be prepared and take out insurance, so you can save money if you ever need care.

9Health insurance options for legal immigrants

Immigrants who are lawfully present in the United States are eligible for private US health insurance. In addition, depending on their income, legal immigrants may qualify for lower monthly premiums and reduced out-of-pocket costs:

• People with an annual income between 100% and 400% of the federal poverty level may qualify for premium tax credits and other savings on Marketplace coverage. From January 1, 2027, among immigrants this applies only to green card holders, Cuban/Haitian Entrants and migrants from the COFA nations.

In most cases, "qualified non-citizens" are eligible for coverage through Medicaid and the Children's Health Insurance Program (CHIP), provided they meet the income and residency rules of the state they live in.

The following people count as "qualified non-citizens":

• Lawful permanent residents
• Asylees, refugees, battered non-citizens and their spouses, children or parents, victims of human trafficking and their spouses, children, siblings or parents, or people with a pending application for a trafficking victim visa
• Cuban/Haitian entrants,
• People paroled into the US for at least one year
• People granted conditional entry before 1980
• People granted withholding of deportation, as well as members of a federally recognized Indian tribe or American Indians born in Canada.

Most of them, however, have to wait 5 years in the US after qualifying before they can receive Medicaid and CHIP coverage. Refugees and asylees are exempt from this waiting period.

States can also choose to waive the five-year waiting period for children and pregnant women so they can be covered by Medicaid and CHIP.

10Health insurance options for undocumented immigrants

Undocumented immigrants in the US can only get health insurance from private providers, because government-funded health insurance programs do not cover them.

Community health centers, known as "safety net providers", can offer medical care to undocumented immigrants in the US, provided the patient is able to pay for the care.

For an overview of medical care, see our page Healthcare in the USA. The differences between plan types are explained in HMO, PPO, POS & EPO, the cost question is answered in How much is the average US health insurance premium?, and how insurance fits into your move is covered in Health insurance when moving to the US.

In short

• The US has the most expensive healthcare system in the world, yet no insurance covering the whole population. Most people are insured through their employer.
• The public programs are Medicare from age 65 and for certain conditions, Medicaid for people on low incomes, and CHIP for children.
• The Affordable Care Act lets children stay on their parents' plan up to age 26. The federal penalty for being uninsured no longer applies since tax year 2019.
• US authorities do not require health insurance for B-1/B-2 visitors, but it is still strongly recommended.
• Immigrants living lawfully in the US can buy private insurance. Whether subsidies, Medicaid or CHIP apply depends on status, income and waiting period.

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